Know the Risks of Catching Rabies When Travelling in Asia

Know the Risks of Catching Rabies When Travelling in Asia

Stray dogs and cats are a common sight when visiting Asia. For many animal lovers it’s a temptation to pet them, or even feed them, but travellers need to be aware of the danger of contracting rabies should they be bitten or scratched by an animal in Asia.

Whilst stray dogs are the main carrier of the rabies virus in Asia, some pet dogs might also carry the virus if they have not been vaccinated against the disease and are bitten by another animal carrying rabies.

That’s especially the case in rural areas or poorer countries where there is no compulsory vaccination of pets, or where pet owners can’t afford the cost of vaccinations.

Many monkeys carry a type of rabies virus too, and as cute as it might be to pose for selfies with the monkeys that live around temples, gardens, and monkey forests in many countries of Asia, monkeys can become quite aggressive if they sense that their human visitors are carrying food.

Monkeys are cute but can be rabies carriers too. Image: © Arun Bhargava

Bats are another carrier of rabies, but few travellers actually handle bats. They are more a danger to adventurers exploring caves or trekkers who may be hammock camping (although mosquito netting will generally keep bats away from a sleeping camper).

Travellers from countries like the Australia, New Zealand, the United Kingdom and most of western Europe are often unaware of the risks of contracting rabies when visiting Asia, because the disease is almost unknown in their home countries.

A tourist from Norway visiting the Philippines in 2019 became the first person to die from rabies in Norway. She had been bitten by a stray puppy in the Philippines, and upon returning to Norway became ill. As there had been no cases of rabies in Norway for more than 200 years, doctors did not immediately think to test for the virus. By the time it became apparent from her symptoms that she had rabies, it was too late to undertake treatment.

Travellers from the United States and Canada are generally more knowledgeable about rabies because there are many wild animals in North America that carry rabies viruses, so they tend to be more cautious when handling animals in Asia than visitors from other western countries.

Dogs on Jimbaran Beach, Bali, Indonesia. Image: Wai Ting Tan

More than 30,000 people are killed by rabies in Asia every year. About two-thirds of those are in India where there is a very large population of stray dogs carrying the virus. But canine rabies is prevalent in many other countries too, especially Cambodia, China, Myanmar, Nepal and Thailand.

The only countries and territories in Asia that have been declared rabies-free are Japan, Singapore, Hong Kong and Macau.

Taiwan was also rabies-free for many decades, but the virus was rediscovered in wild ferret badgers in 2013. Malaysia was rabies-free too for a long period, but lost that status in 2017 when a rabies outbreak occurred in Sarawak – most likely introduced by dogs crossing the border from Indonesia.

In 2010, medical researchers from the Faculty of Tropical Medicine, Mahidol University, Bangkok, the Thai Red Cross Society, and the King Chulalongkorn Memorial Hospital, Bangkok, published the results of a survey undertaken amongst foreign backpackers in 2008 to determine their knowledge of the risks of contracting rabies when in Thailand.

Petting stray dogs carries risks in rural Thailand. Image: Mbalimbali

The backpackers were aged from 14 to 73 years old. The survey found that whilst about 80 percent of the visitors had sought health information before travelling, only 55 percent had received any information about the risks of contracting rabies.

That was a result that concerned the researchers because whilst rabies is a disease that is treatable with a 100 percent recovery rate, it requires patients to take immediate action if they are bitten or scratched by an animal that could be carrying the virus. Otherwise it is likely to be fatal.

Rabies is not a disease that your body’s immune system will cure on it’s own without medical intervention. And it’s definitely not a disease that can be cured with herbal remedies, despite unfounded claims made by some herbalists in India.

It requires immediate treatment in a hospital emergency room or rural animal bite clinic. Therefore knowledge of how and where rabies might be contracted, and what to do in a situation where an animal bite occurs, is vital to recovery.

Pet dogs may not have been vaccinated against rabies. Image: Waihs

According to the Centers for Disease Control and Prevention, 98 percent of rabies deaths in humans are caused by canine rabies. Whilst bites and scratches from cats, bats and monkeys account for only a very small number of deaths overall, they should nevertheless be treated as seriously as dog bites.

Rabies is 100 percent preventable, but it is essential that treatment commence as soon as possible after the bite or scratch. It is important to thoroughly clean any wounds with water and disinfectant immediately after exposure, and then go to the nearest hospital or animal bite clinic.

Be aware too that rabies can also be transmitted by a rabid dog licking a wound or sore on a person’s skin, even if the dog hasn’t bitten or scratched. According to IAMAT’s Travel Health Journal, even a friendly dog licking a person’s face can transmit rabies because the virus can enter the body through the mucous membranes of the mouth or nose.

Although most rabid dogs may show some signs of aggression or appear unsteady on their feet, that’s not always the case, and it is possible that a dog that does not look unwell could be carrying the virus.

An inquisitive stray dog on a beach in India. Image: Varun Kulkarni

Treatment comprises of a course of four or five injections, which are known as Post Exposure Prophylaxis (PEP), which must be administered as soon as possible after it is suspected that infection has occurred, and before any symptoms appear. The treatment will be carried out over a period of 2-4 weeks.

For travellers to countries where rabies is prevalent, and where they feel there may be a risk of being bitten or scratched by a stray dog, it is recommended that they be vaccinated against rabies before leaving home. Rabies vaccinations do not provide complete immunity, but they reduce the number of PEP injections required to one or two.

If travelling to remote regions in Asia, where reaching a hospital or animal bite clinic may take some time, it is essential that travellers be vaccinated in advance.

Rabies is a very serious disease that is almost always fatal if not treated before symptoms appear. Whilst that is not a reason to be concerned about travelling to Asia, it is important that you research and be fully informed about the risks of contracting rabies in the countries that you may be visiting.

Nearly all tourist deaths from rabies have occurred after the tourists returned to their home countries without seeking treatment. They were neither aware of the treatment available for rabies, nor aware that once symptoms appear it is invariably too late for treatment. That lack of knowledge had fatal consequences.

Header image: Nikki Gensert

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